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SR-334 > TYPE I DIABETES > Flashcards

TYPE I DIABETES Flashcards

1
Q

Type I Diabetes

A
  • pancreas doesn’t produce enough insulin
  • islets of langerhans play a crucial role in glucose homeostasis
  • islets are predominantly made up of insulin-secreting beta cells and glucagon secreting alpha cells
  • beta cells are destroyed by autoimmune destruction of insulin producing beta cells resulting in hyperglycaemia
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2
Q

Hyperglycaemia Definition

A
  • excess of glucose in the blood stream
  • high blood sugar
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3
Q

Beta Cell Destruction

A
  • insulin binds to receptor
  • Akt signal cascade
  • GLUT-4 translocation
  • glucose entry permitted
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4
Q

Beta Cell Destruction - Microvascular Impacts

A
  • retinopathy
  • nephropathy
  • neuropathy
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5
Q

Beta Cell Destruction - Macrovascular Impacts

A
  • cerebrovascular disease
  • coronary artery disease
  • peripheral artery disease
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6
Q

Laing et al., 2003 - T1D

A
  • associated with greater heart disease risk and mortality compared with age matched people without diabetes
  • lower life expectancy in T1D
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7
Q

Insulin Therapy

A
  • two primary administration methods; insulin pen, and insulin pump
  • both injected into subcutaneous layer
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8
Q

Insulin Analogues

A
  • developed to better mimic physiological insulin secretion
  • human insulin clusters together
  • re-arranging amino acids or adding to the structure of insulin means clustering can be lessened or encouraged to change properties
  • rearrange amino acid structure to go from peptide hormone to effectively a protein
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9
Q

Insulin Analogue Profiles - Bolus

A
  • rapid action insulins
  • take alongside a meal
  • counters steep rise in blood glucose from the meal
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10
Q

Insulin Analogue Profiles - Basal

A
  • background, longer lasting insulin
  • inject 1/2 times a day
  • slow release - doesn’t all spill into the blood stream at once
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11
Q

Battelino et al., 2019 - Blood Glucose Levels

A
  • hypoglycaemia <3.9mmol/L (<70mg/dL)
  • hyperglycaemia >10mmol/L (>180mg/dL)
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12
Q

Cryer et al., 2008 - Hypoglycaemia

A
  • no pancreatic insulin release; altered alpha-beta cell signals (reduced glucagon release); exogenous insulin poorly regulated
  • attenuated AD response to falling BG (IAH)
  • antecedent hypoglycaemia, and a reduced SNS response means the AD response to falling BG is shifted to a lower threshold
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13
Q

Managing T1D

A
  • blood glucose check
  • HbA1c check
  • food diary and blood glucose log
  • continuous glucose monitoring systems
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14
Q

Bohn et al., 2015 - Health Benefits of Exercise

A
  • better glycaemia
  • better BM
  • better blood pressure (except SBP)
  • combats risk of T1D specific concomitant conditions
  • related to a reduced HbA1c
  • better blood lipids
  • fewer complications (except severe hypos)
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15
Q

Bohn et al., 2015 - Benefits of Regular Exercise

A
  • lower blood pressure
  • improved muscle health, strength and function
  • improved bone health - lower risk of osteoporosis and fractures
  • improved insulin sensitivity and exercise (induced glucose uptake lead to lower insulin requirements
  • lower risk of diabetic neuropathy and nephropathy
  • possible beta cell preservation
  • greater aerobic capacity
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16
Q

Colberg et al., 2015 - Factors That Affect BG During Exercise

A
  • exercise
  • environment
  • regimen changes (starting BG levels, food intake etc)
  • bodily concerns
  • hypoglycaemia-associated autonomic failure
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17
Q

Brazeau et al., 2008 - Barriers to PA

A
  • frequency of hypoglycaemia
  • busy work schedule
  • loss of gylcaemic control
  • pre-existing low levels of fitness
18
Q

Acute Exercise Management Strategy

A

Fall:
- decrease insulin
- increase CHO intake
Rise:
- omit/increase insulin
- decrease/omit CHO intake

19
Q

McCarthy et al., 2020 - Aerobic Exercise on BG

A
  • glucose production outweighed by uptake from cells
  • glucose uptake is insulin dependant and independent
  • blood glucose declines
20
Q

Management Strategies Around Exercise

A
  • check glucose regularly
  • additional CHO intake
  • adjustment to insulin dosing
21
Q

West et al., 2010 - Pre-Ex Rapid-Acting Insulin and BG

A
  • 75% reduction in pre-ex insulin results in greatest preservation of blood glucose, and a reduced dietary intake, for 24h after running
22
Q

West et al., 2011 - LGI CHO Ingestion Pre-Exercise

A
  • LGI CHO 2h pre-ex better preserved post-ex glucose for 3h compared to isoenergetic HGI CHO
  • bolus insulin reduction LGI CHO adjustments made 30min before running produced similar post-run BG concs as those at 2h pre-ex
  • LGI CHO consumption and reduced rapid acting insulin need to not be made 24h pre-ex
23
Q

Campbell et al., 2015 - Glargine and Exercise

A
  • 20% reduction in glargine and bolus insulin reduction eliminates nocturnal hypoglycaemia
24
Q

Heise et al., 2016 - Post-Exercise Hypoglycaemia

A
  • same risk of post-ex hypoglycaemia on deglude as glargine
25
Q

Van Dijk et al., 2016 - Daily Walking Exercise

A
  • 26±16% reductions in daily insulin requirements in daily walking 40-50km over 4 days
26
Q

McMahon et al., 2007 - Strategies to Reduce Post-Ex Hypoglycaemia

A

Nutritional intake
- LGI CHO meal (1g CHO/kg) 1-2h after ex to reduce early onset hypoglycaemia and replenish glycogen stores
- if ex is done in late afternoon/evening, small pre-bed LGI CHO snack (~0.4gCHO/kg) without insulin to reduce nocturnal hypos
- include protein in post-ex meals to reduce risk of ‘double-dip’ hypos
Glucose Monitoring
- frequent monitoring of glucose/ CGM for several hours post-ex

27
Q

Fahey et al., 2012 - Sprinting and BG

A
  • 10s sprint causes decline in glucose Rd rather than form a disproportionate rise in glucose Ra relative to glucose Rd as reported with intense aerobic exercise
28
Q

Harmer et al., 2007 - Sprinting and BG

A
  • acute intermittent maximal exercise causes hyperglycaemia in T1D and con
  • affect attenuated by regular exercise
29
Q

Bassau et al., 2006 - Sprint After Aerobic-Ex

A
  • 10s max-effort sprint after moderate intensity-ex provides another means to reduce hypoglycaemia
30
Q

Bassau et al., 2007 - Sprint Before Aerobic-Ex

A
  • 10s max-effort sprint performed immediately before moderate intensity-ex prevents glycaemia from falling during early recovery from moderate-intensity-ex
31
Q

Campbell et al., 2014 - Simulated Soccer and Hypoglycaemia

A
  • simulated soccer has lower risk of early but not late onset hypoglycaemia than continuous running
32
Q

Scott et al., 2019 - HIIT

A
  • 6 weeks of HIIT improved VO2peak and aortic pulse wave velocity (aPWV) to a similar extent as moderate-intensity continuous training (MICT)
  • BG levels remained stable during HIIT in fed state but consistently fell during MICT
  • HIIT may be preferred training method for T1D
33
Q

McCarthy et al., 2021 - Cardiopulmonary Exercise Testing (CPET)

A
  • stable BG responses to CPET
  • pre-ex hyperglycaemia didn’t influence subsequent glycemic dynamics, it did potentiate alteration in various cardiac and metabolic responses to CPET
  • HbA1c a significant factor in determination of peak performance outcomes in CPET
34
Q

What is Resistance Exercise?

A
  • the use of resistance to muscular contraction to increase muscle strength, endurance, power or size
35
Q

Turner et al., 2015 - Glycemic Effects of RE

A
  • doesn’t induce acute hypoglycaemia or damage muscle
  • BG progressively rose after 1 and 2 sets of RE
  • 3rd set of RE reduced exercise-induced hyperglycaemia and returned BG to non-exercise levels
36
Q

Turner et al., 2015 - Individualised Rapid-Acting Insulin Dose Algorithm

A
  • administration of rapid-acting insulin according to an individualised algorithm reduced the hyperglycaemia associated w morning RE without causing hypoglycaemia in 2h post-ex
37
Q

Calculation of Post-Exercise Rapid-Acting Insulin Dose

A
  • TDD / 100 = CF
  • 0’ minute post-ex BG - 7 = T
  • CF x T = Full dose
  • 50% x Full dose = A dose
38
Q

Yardley et al., 2012 - RE and Aerobic Exercise

A
  • performing RE before aerobic ex improves glycemic stability throughout ex and reduces the duration and severity of post-ex hypoglycaemia
39
Q

Aerobic Exercise Overview

A
  • reduction in rapid-acting insulin before exercise
  • ingesting an upper limit of 1g LGI CHO per kg BM per planned hour ex as LGI CHO solution
  • make adjustments 30-60 mins pre-running
40
Q

Strength Exercise Overview

A
  • morning sessions, avoiding bolus before ex, little to no CHO
  • if >30 min have recovery CHO handy
  • if <30 min administration of bolus to reduce post-ex hyperglycaemia

SR-334 (7 decks)

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